Comprehensive school health (CSH) is a widely recognized and implemented approach to improve the health of students and school communities (Faught et al., 2017; JCSH, 2021; Gleddie, 2012; Gunther et al., 2015). CSH helps to bridge the gap between education and health, addressing health related issues in the school setting. Implementation of a CSH approach has been shown to contribute towards improving health, well-being and learning (McIsaac et al., 2012; IUHPE, 2009) through collaboration with home, school, and community partners (Naylor et al., 2006; Roberts et al., 2015; Veugelers & Schwartz, 2010). Furthermore, the implementation of CSH can play a vital role in student development including critical thinking (what sorts of foods should be available in schools), leadership skills (student led school initiatives, such as active transportation week), problem-solving (dealing with contextual issues, such as space for physical activity) and emotional well-being (role of a healthy school community on student social-emotional competencies) (Hoyle, 2008; Stewart-Brown, 2006; Young et al., 2008).
Ever Active Schools (EAS) is a national charity based in Alberta whose vision is that, “All students belong to healthy school communities that enable optimal health and learning” (EAS, 2021). One of the ways that EAS has supported school communities across Alberta was through learning and sharing events called the Healthy Active School Symposium (HASS). Focused on the CSH approach, these locally hosted events evolved over a number of years to invite school teams (teachers, students, administrators, community partners, and parents) to come together to learn, play, plan, discuss and share all in the context of creating and supporting healthy school communities. The HASS events played a vital role for EAS to disseminate information, connect with school communities and gather and share information about health and wellness practices and policies in schools (EAS, 2021). Although each HASS was slightly different to account for local contexts and resources, there were common threads to these one-day learning opportunities. All schools were invited to bring a ‘team’ (defined by the school but including students, teachers, administrators, parents and community members) and engage in EAS workshops, planning and discussion sessions, resource dissemination and, small and large group sharing. Local events differed in keynote presentations and targeted sessions by local groups (such as Alberta Health Services staff). Over the course of 4 years in which 27 HASS events were held, EAS gathered exit surveys from teachers attending these events. The purpose of this study was to use the survey results to determine the efficacy of the HASS events to support school communities to implement CSH.
The HASS survey was created in collaboration between EAS and the Alberta Centre for Active Living to specifically evaluate the events. Ethics approval from the research University was received. Data collected across four consecutive years (2014 to 2018) were used to run the analyses. Teachers who attended the event were invited to complete the post-event survey which consisted of 28 items including 20 questions categorized under three areas: a) contributions towards the development of a school health team (7 questions), b) the effectiveness of the HASS in facilitating school health initiatives (6 questions) and, c) contributions to health and wellness in the school community (7 questions). Participants responded to the items in the questionnaire based on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Participants included 747 teachers (the survey was only open to teachers due to ethical considerations) from 27 different HASS events conducted across Alberta within 30 different self-identified communities.
Data for this study was analyzed using descriptive statistics including mean, standard deviation, and percentages. Results are shared in Tables 1-3 with questions grouped according to the three areas shared earlier.
Table 1: HASS contributions towards the school health team
Approximately 95% (“agree” and “strongly agree”) of the participants indicated that the HASS events allowed students on the school team to think critically (95.4%) and communicate their ideas (96.1%) about school health and wellness. The HASS events helped students (84.1%) and school teams (86.2%) to set clear steps towards achieving their healthy school action plan. Survey data also showed that the HASS events were effective in supporting (79.9%) and identifying problems (86.9%) related to personal growth, health and wellness among school teams. Further, 86.1% of the participants agreed and strongly agreed that HASS helped the school team develop a useful healthy school inquiry plan and indicated they were confident their school health team could implement the plan (92.4%). Across the four years of the HASS events, scores on most items in the area of ‘contributions towards the school health team’ stayed consistent or increased from year 1 to year 4.
Table 2: HASS effectiveness in facilitating school health initiatives
Teachers reported (“agree” and “strongly agree”) that participating in a HASS was beneficial in creating (79.4%) and implementing (68.6%) policies on health and wellness for school jurisdictions. The HASS events were rewarding in terms of enhancing connections with their own schools (67.9%) as well as with other school communities (46.1%) for facilitating health and wellness. Further, 69.8% of participants reported they would attend future HASS events and recommend others to do the same (69.2%) (“agree” and “strongly agree”). Lastly, across the four years of the HASS events, scores on most items in the area of ‘effectiveness in facilitating school health initiatives’ stayed consistent or increased from year 1 to year 4.
Table 3: HASS contribution towards health and wellness in school community
Approximately 63.0% (“agree” and “strongly agree”) of the participants reported the HASS events were useful in learning what other schools are doing to create a healthy school community. The HASS events also showed efficacy in the identification of community resources (49.9%) and provincial organizations (52.9%) to support health and wellness in schools. Further, approximately 60% (“agree” and “strongly agree”) of participants reported the HASS events to be useful in providing resources for Healthy School Inquiry Action Plan on Physical Activity (59.3%), Healthy Eating (62.4%), Mental Well-Being (60.7%) and enhancing Student Leadership (62.8%). Notably, participants were less satisfied with the physical activity and mental well-being resources than healthy eating and student leadership resources. However, the data showed an increase from year 1 to year 4 in satisfaction with resources on physical activity (76% vs. 85.5%). Interestingly, in year 2 and year 3, participants reported higher satisfaction with mental well-being resources (82.5 % and 83.6%) than year 1 and 4 (77.7% and 76.5%).
Given the potential role that a CSH approach can play in the health and education of children and youth (Faught et al., 2017; JCSH, 2021; Gleddie, 2012; Gunther et al., 2015) the main objective of the study was to determine the efficacy of the HASS events to support school communities to implement CSH. Overall, the HASS events were effective in supporting schools in the development of a school health team, facilitating school health initiatives and contributing to health and wellness in the school community.
An increasing number of Canadian schools are taking on the responsibility to promote health behaviours in a school setting through whole-school approaches (Beaudoin, 2011; Gleddie 2012; Storey et al., 2011; Sulz et al., 2016). However, limited research has examined ways in which support can be provided to schools in the development and implementation process of whole-school health initiatives. Our study adds to the literature by examining the effectiveness of partnerships from an external organization (i.e., Ever Active Schools) to help school communities in the implementation of a CSH approach. Storey et al. (2016) identified essential conditions of CSH implementation including the need for internal and external partnerships in alleviating the pressures of implementation. Our results demonstrated effectiveness supporting the initial stages of the planning and development of CHS with participants reporting that HASS events helped the school team (86.2%) to set clear steps towards achieving their healthy action plan.
For a CSH program to be effective, time needs to be allocated to the planning and implementation of new initiatives, as the new approach is not part of teachers’ regular workload (Sulz et al., 2016). Time is often cited as an important factor in ensuring that CSH is prioritized in a busy school environment (Samdal & Rowling, 2011; Stolp, Wilkins, & Raine, 2015; Storey et al., 2016, Sulz, et al., 2016). Sulz et al. (2016) reported lack of time for the planning of CSH initiatives alongside the daily responsibilities of students, teachers, and administrators inhibited perceptions of competence toward the implementation of whole-school health approaches. The use of teacher release time or an alternative method of allocated time, such as professional development days, were recommended as teachers reported difficulty finding time in their daily schedule to plan and implement the CSH action plan (Sulz et al., 2016). The HASS events assisted in the initial stages of a healthy school community where significant time is needed to engage in the planning and development stages of CSH. The HASS events were an effective platform to devote time to the planning of CSH for school health teams and developed confidence that their team could develop a healthy school inquiry plan (86.9%) and implement the plan into their school practices (92.4%).
Previous literature has also noted the importance of collaboration with others in the planning and implementation of CSH approaches (Stolp et al., 2015; Storey et al., 2016; Sulz et al., 2016). Stolp et al. (2015) discussed the importance of sharing experiences between school teams within the same school district to share ideas about health promotion activities and empathize about similar challenges to the implementation of a whole-school health approach. Further, Gleddie (2012) stated that implementing a whole-school health approach requires building quality relationships and establishing lines of communication between different levels of the school community (e.g., administration, staff, parents, students). The HASS events demonstrated effectiveness in allowing time for school teams to communicate their ideas (96.1%) about school health and wellness as well as allow opportunities for enhancing connection with participant’s own (67.9%) and other schools in communities (46.1%). Notably, participants also indicated that HASS events allowed students on the school team to think critically (95.4%) and communicate their ideas (96.1%) about school health and wellness. Students as change agents have been identified as critical to school change initiatives (Fullan, 2001), including CSH approaches (Neely, Montemurro, & Storey, 2020; Storey et al., 2016; Sulz et al., 2016). Educational change literature suggests that the integration of new programs into existing school practices is more likely when student voices and ideas are taken into consideration (Fullan, 2007; Niemiec & Ryan, 2009; Reeve, 2012). A strength of the HASS was the presence of students and the integration of student voices in the planning and implementation of CSH activities.
Although we have indicated earlier in the paper that most scores across the three categories stayed the same or increased, there are some variables across the years that merit further consideration. For example, in the category of ‘contributions to the school health team’ the items (Table 1) about communication and developing clear steps dipped in year four from relatively consistent scores in prior years. EAS staff would be well served to inquire deeper into the changes that occurred between those years to address these issues. “Charting a unique plan” (Canadian Healthy Schools Alliance, 2021, p. 15) is an essential element for CSH and should not be neglected in learning events such as the HASS. Similarly, in Table 2, the item featuring connections with other school communities was significantly lower in years two and three compared to the first and last years surveyed. Why might this have been the case? What changed across the agendas that might have caused school communities to feel less connected with each other? Table 3 shows a similar dip for the identification of resources in years to two and three as well as a variance between the provision of resources across the four areas (physical activity, healthy eating, mental well-being and student leadership). Although the HASS events can certainly be seen to be successful overall, inquiring further into why there might be these small changes will be helpful. As well, the entire process of surveying and analyzing could be done each year to provide evidence and feedback as the events evolve and contexts/ focus may change from year to year (Canadian Healthy Schools Alliance, 2021).
School teams responsible for the planning and implementation of CSH approaches need support, time, and resources to effectively implement and sustain approaches into existing school practices (Sulz et al., 2016). The value of CSH and its impact on health and educational outcomes has been well-established in the literature (Gunther et al., 2015; Hoyle et al., 2008; McIssac et al., 2021; Neely et al., 2020). Yet, an undervalued and under researched aspect of CSH is how best to support teachers, students, and administrators in the adoption, implementation, and sustainability of such approaches. A promising new development is the Canadian Healthy School Standards, developed by the Canadian Healthy School Alliance (2021) of which EAS is a key member. This resource offers support to system leaders and encourages accountability at the leadership level for things like dedicated time and budgets, aligning with our findings. In the future, it may be necessary for external organizations like EAS to support school health teams in the planning and implementation of CSH. These partnerships may be critical in a time in which the nature, volume and content of teachers’ and administrators’ work is changing (Alberta Teachers Association, 2020; Pollack, Wang, & Hauseman, 2014).
Lauren Sulz, Associate Professor, University of Alberta
Douglas Gleddie, Professor, University of Alberta
Md. Dilsad Ahmed, Mitacs Postdoctoral Researcher, University of Alberta
Brian Torrance, Director, Ever Active Schools
Katelynn Theal, Assistant Director, Ever Active Schools
Nora Johnston, Director, Alberta Centre for Active Living
Soultana Macridis, Research Associate, Alberta Centre for Active Living
Christina Loitz, Research Associate, Alberta Centre for Active Living
Jessica Walker, Research Assistant, Alberta Centre for Active Living
Dorah Conteh, Research Assistant, Alberta Centre for Active Living
Mitacs PostDoctoral Fellowship funding